Sex-Specific Anatomic Differences in Patients Undergoing Transcatheter Aortic Valve Implantation: Insights from the ST-TAVI Registry.

Background: Anatomic considerations of transcatheter aortic valve implantation (TAVI) have an important role for the procedure planning, but sex-specific data are lacking.

Methods: All eligible cases undergoing evaluation for TAVI procedure in the period from November 2019 to July 2023 at the University Hospital of Split were included. Cardiac computed tomography was analysed to derive the measures of left ventricular outflow tract (LVOT), aortic root, ascending aorta, and ilio-femoral arteries. Sex-based comparison was conducted using the descriptive statistics.

Results: There were 140 female patients (43.8%) and 180 male patients (56.2%). Female patients had smaller dimensions of aortic annulus (area 391.9 vs. 491.5 mm2, p<0.001), LVOT (area 373.3 vs. 481.8 mm2, p<0.001) and ascending aorta (maximal diameter 32.7 vs. 34.5 mm, p<0.001), as well as ilio-femoral arteries bilaterally (p<0.001). There was no significant difference in the proportion of ilio-femoral unfeasibility for transfemoral TAVI procedure, as measured by diameter of ilio-femoral arteries <5.0 mm (9.0% in males vs. 6.1% in females, p=0.441) and <5.5 mm (24.7% in males vs. 16.7% in females, p=0.156). Female patients were more likely to receive the smallest valve across different valve platforms (p<0.001). There were sex-specific differences in the availability of conventional valve sizes across different platforms (p<0.001). Female patients had significantly higher periprocedural mortality (7.9% vs. 1.7%, p=0.030), while there were no differences in other clinical outcomes, and no association of periprocedural mortality with anatomic measures.

Conclusions: Female patients showed smaller absolute dimensions of LVOT, aortic root and ilio-femoral arteries compared to male patients. There were no differences in the prevalence of ilio-femoral unfeasibility for transfemoral TAVI procedure, but there were sex-specific differences in the availability of conventional valve sizes across different platforms. Female patients exhibited higher periprocedural mortality with no difference in other clinical outcomes.